Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 010073-1 | NY |
NPI | 1033362579 |
---|---|
Provider Name | Mrs. Rebecca Hyde Miles |
First Address | Waterford, NY 12188-1093 |
Second Address | Waterford, NY 12188-1093 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2008 |
Last Update Date | 21/04/2015 |